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CBSSM Researchers: 

Funded by National Institutes of Health; National Institute on Aging

This is competing continuation proposal for Years 23-28 of the Health and Retirement Study (HRS) cooperative agreement, in response to NIA RFA #AG-12-001. We propose to continue core data collection on the steady-state design laid out in the two previous renewal cycles, and collect biomarkers and measures of physical performance in in-person interviews on the rotating half-sample design established in the previous cycle.

PI(s): Sharon Kardia/David Weir

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4.7 million people in the United States had Alzheimer's disease in 2010, a number that is projected to nearly triple by 2050. While the National Plan to Address Alzheimer's Disease and Related Dementias is an effort to coordinate federal, state, and local efforts to confront this growing challenge, it explicitly states “this is a national plan and not a federal plan”, with individual states left to determine how to best care for these patients and their caregivers. Because of cognitive and functional changes as age-related dementia progresses, the needs of these patients and their caregivers extend far beyond healthcare, requiring a diverse response from states. However, the care most accessible to community-dwelling patients with age-related dementia is direct medical care. In addition, as a patient's ability to direct their own care declines, the healthcare provided to them may be driven by the needs and preferences of the caregiver. These patients then experience: fragmented medical care, poorly-coordinated across multiple outpatient providers; potentially preventable hospitalization; and overuse of antipsychotics despite extensive evidence of harms. Because of the state-led nature of the National Plan, it is critical to provide states with key predictors of this inappropriate care to help guide their policy. We will use national Medicare data, a national survey of older adults with dementia and their caregivers, and an Expert Panel of researchers and state policy experts to complete the following aims: (1) Identify patient and community factors associated with potentially inappropriate care delivered to community- dwelling adults with age-related dementia and establish accurate national and state-level estimates of this care. We will use a cross-sectional Medicare 20% sample to determine use of the following for all 50 states: a) potentially-preventable hospitalization; b) fragmented outpatient care; and c) antipsychotic use. (2) Determine the contribution of additional patient clinical, functional, caregiver, and caregiving characteristics to potentially inappropriate care relative to the effect of location. We will use the National Health and Aging Trends Study, National Survey of Caregivers, and Area Health Resource File to determine the patient, caregiver, and regional healthcare system characteristics associated with potentially inappropriate medical care for persons with dementia. (3) Develop an evidence-based policy making guide for dementia that we will use to interview state aging policy officials. An Expert Panel of dementia researchers and state aging policy experts will apply our Aim 1 and Aim 2 findings to develop an evidence-based policymaking framework with particular emphasis on populations most at risk, which we will use to guide interviews with state aging policy officials. The impact of our work will be to: 1) identify the patient, caregiver, and regional factors that contribute to potentially inappropriate medical care for patients with age-related dementia; 2) provide a baseline against which to measure future system-level interventions; and 3) develop a framework for states to develop evidence-based dementia care state plans.

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CBSSM Researchers: 

Funded by NIH - National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

The central hypothesis of this study is that early patient CKD education combined with health coach support will improve patient behaviors aligned with blood pressure control by increasing patient knowledge, self-efficacy, and motivation. These in turn will lead to optimal health behaviors and improved blood pressure control. The long-term goal of this research is to develop, test, and disseminate sustainable patient-centric education and coaching support interventions to improve quality and outcomes in CKD. The objective of this proposal is to test the impact of a pilot-tested, provider-delivered patient education tool, followed with health coaching focused on blood pressure control. A cluster-randomized controlled trial will compare outcomes in patients with CKD stages 3-5 between intervention and control groups in primary care settings. Continuous quality improvement and systems methodologies will be used to optimize resource neutrality and identify how to leverage existing technology and resources to support implementation and future dissemination. Involving local partners from a state-wide primary care practice-based research network will support future transferability and uptake into community settings.

This project seeks to identify concrete policies and practices that can better serve both people and institutions in building local, state, and national health information systems necessary to maximize the potential of data throughout its life cycle. We will focus on five intertwined and endemic issues to the life cycle of data that arise in precision oncology: (1) informed consent, (2) duration of specimen storage; (3) storage of germline DNA sequence data (4) disclosed commercialization; and (5) data sharing at local, state, and national levels. Our proposed research will identify public preferences for specific policies and practices governing these issues thus addressing a major gap in understanding how the public views data as it flows across functional boundaries - clinical care, quality improvement, research and public health - and across local, state, and national levels.

There is a fundamental gap in understanding how Mild Cognitive Impairment (MCI) influences treatment and Decision Making for serious illnesses, like Cardiovascular disease (CVD), in older patients. Poor understanding of Clinical Decision Making is a critical barrier to the design of interventions to improve the quality and outcomes of CVD care of in older patients with MCI.

CBSSM Researchers: 

Specific aims are to (1) examine the impact of a family-based preventive intervention on outcomes of parent-child relationships, family functioning, and child mental health using a Hybrid Type 2Effectiveness-Implementation Design (families with children aged 7-17 in a two-arm randomized controlled trial); (2) identify barriers and facilitators to implementation of the FSI-R by community health workers by conducting a process evaluation concurrent with the delivery of the intervention; and (3) strengthen the science of community engagement to address health disparities by fortifying CBPR-based pathways of change via collaborative partnerships between refugee communities, service providers, and academic stakeholders.

Investigators from University of Michigan’s Institute for Healthcare Policy and Innovation (IHPI), in partnership with the Detroit Health Department, the Southfield-Joy Community Development Corporation and five health plans insuring Detroit-based Medicaid and Healthy Michigan enrollees have collaboratively developed an innovative new model for a Community Health Worker-led (CHW) demonstration project in Detroit’s Cody Rouge neighborhood. The demonstration project will evaluate a potentially financially sustainable model targeting neighborhoods with high numbers of high- and under-health care utilizing Medicaid enrollees.

CBSSM Researchers: 

Funded by National Institute of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI)

SPECIFIC AIMS : 1) Develop a re-organized model of peri-procedural anticoagulation care within six diverse healthcare centers using health systems engineering methods; 2) Develop an implementation strategy for a re- organized model of peri-procedural anticoagulation management of atrial fibrillation patients within a diverse group of healthcare centers; and 3) Perform a single-center pilot study of implementing a re-organized peri- procedural anticoagulation delivery model emphasizing improved intra-organizational provider coordination and communication. RESEARCH PLAN: To accomplish these aims, Dr. Barnes will perform direct observations and semi-structured interviews with key stakeholders to develop and then optimize a work flow model for evidence-based peri- procedural anticoagulation management. He will then use stakeholder semi-structured interviews to develop an implementation strategy for re-organizing per-procedural anticoagulation management. Finally, he will perform a single center pilot study where the re-organized anticoagulation strategy is implemented to assess feasibility, acceptability and efficacy. This study will inform a future multi-center implementation study.

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Post stroke disability represents a significant public health problem as there are over 7 million stroke survivors in the US, most of whom have persistent disability. Despite the fact that acute stroke treatments dramatically reduce post-stroke disability and are cost saving, they are markedly underutilized. There is no region in the US where acute stroke treatments are more underutilized than in Flint, Michigan. Flint is an urban, underserved city of about 100,000 residents of whom about 60% are African American.

In spite of strong evidence showing it offers no clinical benefit and increases the likelihood of unnecessary cesarean delivery, Electronic Fetal Monitoring remains part of routine care given to nearly all patients in labor in the US. Using observations and interviews the research team will identify the barriers to the implementation of this evidence and organize a deliberative meeting with key stakeholders to translate the project’s findings into practical strategies for more ethical and judicious use of EFM.

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